孕妇25-羟维生素D与妊娠期糖尿病相关性分析

Correlation between 25-hydroxy vitamin D and gestational diabetes mellitus

目的分析妊娠期糖尿病(gestational diabetesmellitus,GDM)患者与血糖正常孕妇25-羟维生素D[25-hydroxy vitamin D,25(OH)D)]水平的差异,探讨25(OH)D与GDM、胰岛素抵抗(insulin resistance,IR)、糖化血红蛋白A1c(glycosylated hemoglobin A1c,Hb A1c)的关系。方法纳入妊娠24~28周女性961例,其中GDM患者229例,对照组孕妇732例(对照组)。测量身高、体重,计算体重指数(body mass index,BMI)等,检测空腹血糖(fasting blood glucose,FBG),OGTT 1 h血糖和2 h血糖,测定Hb A1c、空腹胰岛素(fasting insulin,FINS)、血脂及血清25(OH)D水平,计算稳态模型的胰岛素抵抗指数(homeostasis model assessment of IR,HOMA-IR)、胰岛β细胞功能(homeostasis model assessment ofβcell function,HOMA-β)。比较上述指标在2组中的差异,应用Pearson相关分析及多元逐步回归分析评价25(OH)D与各时点血糖、Hb A1c、HOMA-R、HOMA-β等指标的相关性。结果 GDM组血清25(OH)D水平低于对照组(P<0.05),GDM组FBG、1 h血糖、2 h血糖、FINS、Hb A1c、HOMA-IR、HOMA-β和三酰甘油(triglyceride,TG)水平均高于对照组,高密度脂蛋白胆固醇(high density lipoprotein cholesterol,HDL-c)水平低于对照组(P<0.05)。Pearson相关分析显示,GDM组25(OH)D水平与年龄、FBG、FINS、HOMA-IR相关;多元逐步回归分析结果提示GDM组25-羟维生素与年龄独立正相关(β=0.274,P=0.049),与HOMA-IR独立负相关(β=-1.043,P=0.011)。结论GDM患者血清25(OH)D水平较对照组低,25(OH)D水平与年龄及HOMA-IR有关;25(OH)D缺乏可能通过增加胰岛素抵抗影响糖代谢。

Objective To investigate and compare the differences of 25-hydroxy vitamin D levels between patients with gestational diabetes mellitus（ GDM） and normal pregnant women,and to explore the relationship between 25-hydroxy vitamin D and GDM,insulin resistance（ IR）,glycosylated hemoglobin A1 c（ Hb A1 c）. Methods A total of 961 pregnant women with 24 ~ 28 weeks pregnancy were enrolled in the study,including 229 patients with GDM（ GDM group and 732 pregnant women with normal blood glucose levels（ control group）. The height,body mass,body mass index（ BMI） were measured,and the levels of fasting blood glucose,1 h blood glucose,2 h blood glucose,Hb A1 c,fasting insulin,serum lipids and serum 25-hydroxy vitamin D were detected,moreover the homeostasis model assessment of IR and β cell function were performed. The difference of these indexes were compared between the two groups. Moreover Pearson correlation analysis and multiple stepwise regression analysis were used to evaluate the correlation between 25-hydroxy vitamin D levels and blood glucose,Hb A1 c,HOMA-IR,HOMA-βand other variables in every time point. Results The serum levels of 25-hydroxy vitamin D in GDM group were significantly lower than those in control group（ P 〈 0. 05）,however,the levels of fasting blood glucose,1 h blood glucose,2 h blood glucose,fasting insulin,Hb A1 c,HOMA-IR,HOMA-β and triglyceride in GDM group were significantly higher than those in control group,moreover,the levels of HDL-c in GDM group were significantly lower than those in control group（ P 〈 0. 05）. Pearson correlation analysis showed that the levels of 25-hydroxy vitamin D in GDM group were correlated with patient’s age,fasting blood glucose,fasting insulin and HOMA-IR（ P 〈 0. 05）. Multivariate stepwise regression analysis showed that 25-hydroxy vitamin D levels were positively correlated with patient’s age（ β = 0. 274,P 〈 0. 05）,which were negatively correlated with HOMA-IR（ β =-1. 043,P 〈 0. 05） in GDM group. Conclusion The serum levels of 25-hydroxy vitamin D are lower in patients with GDM,which are related with patient’s age and HOMA-IR. Moreover 25-hydroxyl vitamin D deficiency may affect glucose metabolism by increasing insulin resistance.